Asysin2leads

God may tell you to make a latex glove into a balloon for the kids, but the cases of kids choking to death on pieces of these same toys say otherwise. Really, I'm not just being a jerk, this really has happened. I'd suggest making a sock puppet for them but you should see my socks sometime. Anyway, this field will put anybody's beliefs to the test like no other will. I guess my feelings are, if you are strong in your faith, you shouldn't need that much advice on how to keep it, and if your faith is not that strong, keep it, don't test it.

First, I apologize for bringing this up, but I was reviewing some airway stuff the other day and I thought back to the long, exhaustive, and tedious battles that have occured on this board over BLS and combitubes. Since I am of the school of know what you're doing before doing it, I have never been in favor of basics and invasive procedures. That's not what I want to get into. What I was thinking about is, how effective will the combitube really be in absence of ALS procedures. In short, conscious people do not like having things put down their throats. You have to be either unconscious, in arrest, or sedated to let someone put an OPA, let alone an ETT or a combitube in your throat. Now the biggest instance where BLS claims combitubes should be put into practice is in traumas, where a BLS unit rapidly transporting a patient with a patient with a combitube is preferable to waiting for ALS intercept. However, again, unless a person has suffered a head injury and is unconscious, they will still need to be sedated to effectively manage their airway, even with a combitube. So, in my opinion, given my knowledge of airway management and EMS capabilities and experience in the field, the number of patients who can can have their airways effectively managed with a combitube and BLS procedures, in my mind, is very limited. To sum up, really the only people who can be intubated or combitubed without sedation are people who are dead, or people who are unconscious. If you are dead, the combitube isn't going to help, and if you are unconscious, you typically need ALS intervention beyond airway managment. Given these facts alone, I think combitubes and BLS don't mix, combitubes should be utilized as a back up to proper intubation. That's my opinion. Let's hear yours.

I have worked the Puerto Rican day parade. As I feel my comments would unfairly incriminate me in the Courts of Political Correctness, I hereby invoke my 5th Admendment rights against this line of questioning. I concurrently invoke my 5th admendment rights pertaining to my opinions of the political activists who are claiming the police unfairly detained groups of innocent young men and women, just because they happen to be in the same spot and by sheer coincidence, were wearing the same color schemes.

You know, its funny, I have a degree in paramedicine from an NYC institution, I work here professionally, and consider myself very up to date on municipal, city, and national standards for EMS practice, but, still, somehow, these mystery courses that allow people to do things others don't (i.e. EMT-B's with IV's) just continue to befuddle me. Batjka104, I suggest you take a serious look at this 200 hour course, its instructors, and refresh your knowledge of NYC REMAC protocols before playing with the IV's. If this 200 hour course was offered by, oh, I don't know, some volunteer EMS service who like to play by their own set of rules, I humbly suggest you don't listen to them about the whole IV thing before you are arrested, sued, or worse. Bottom line is this, volunteer, paid, or superhero, if you don't have an NYS EMT-B card, you shouldn't be putting on a band-aid withing the five boroughs, and if you don't have a NYS EMT-P card, and a NYC REMAC paramedic certification, sticking someone with an IV is tantamount to practicing medicine, assault in the 1st degree, and anything else the guys down at Centre Street would like to throw at you. There is no getting around it, those are the facts, and that is the law.

On any respiratory call, if there is any question in my mind that the person needs a 12 lead, they get one. The 18 year old who is having an asthma attack isn't going to need a 12 lead, but a 45 year old who thinks they are having an asthma attack will. I have had at least one case on a non respiratory call where a second 12 lead enroute made a routine abdominal pain call into a person who was being prepped for the cath lab as soon as we got to the ER, so I am a big fan of them. I am also a firm believer in Murphy's Law, which is the one respiratory case I chalk up to BS and don't do a 12 lead on will be the one that bites me in the rear later.

Here's a patient I had that I think we all could learn from. Called to a clinic for a report of difficulty breathing. Arrived to find a 36 year old male in obvious respiratory distress with audible rales laying on examination table, on O2 10lpm via NRB. Examining physician states that patient reported not feeling well for several days, came in for check up, was found in current state. Patient speaks no English. Using paramedic's limited knowledge of Spanish, patient complains of difficult breathing, and minor, midsternal, non radiating sharp pain, 4/10. Denies nausea, vomiting, diarrhea, headace. Only history is asthma, uses albuterol pump. Vitals: BP:60/P, HR 130, SP02: 94% on 100% O2, GCS: 15. PE: Patient is pale, cool, perrl, negative cyanosis, trachea midline, negative JVD, positive accessory muscle use, equal chest expansion, bilateral rales auscultated in all fields, abdomen soft, non-tender, negative incontinence, motor, sensory present x 4, unable to palpate peripheral pulses, negative edema. EKG: Sinus tachycardia, rate 130. Presumptive diagnosis: cardiogenic shock. Patient has very poor periphery, as partner attempts external jugular cannulation, I contact telemetry. Without getting into too much discussion of the specifics, the telemetry doctor disagreed with my diagnosis and did not feel comfortable with my request for a dopamine infusion, and ordered normal saline only. Luckily we were less than five minutes away from the hospital. A follow up with the ER physician listed the diagnosis as cardiogenic shock secondary to constrictive endocarditis. So here's my question: Would the dopamine have helped? If you had the carte blanche to do anything with this patient in the field, what would you have done?

Not to excuse the actions of these two, but I will offer this: While the responsibility falls on the two individuals, I believe that part of the problem is the system. The NYC EMS system is incredibly wasteful when it comes to triaging calls. When between the call receiving operators and the dispatch protocols, every patient with a runny nose and a history of a heart murmur 10 years ago becomes a cardiac call type, tragedies like this, when someone is a legitimate cardiac patient, can and do happen. Again, I am not excusing the actions of these individuals, but the purpose of a triage system is to find the critical patients and send the appropriate resources. In New York City, currently, given the dispatch system, an intoxicated person laying on the street gets a full CFR, PD, and ALS response, and call receivers cannot differentiate between someone saying "I'm having trouble breathing" because their nose is stuffed up, and "I'm having trouble breathing" because they are having a heart attack. In a land where everyone is treated as a cardiac patient, the true cardiac patients are treated like everyone else. That's my opinion.

Tips for succesful EMS marriage (coming from an unmarried guy with a history of dubious relationships) 1. Leave your boots at the door. 2. Shower before you come home. 3. Let your job be just that. 4. Work hard to make up for the times you're not there. 5. Let them know they are more important than strangers are. 6. Be glad to come home. Follow those tips and you won't end up in divorce court, and your relationship will last much longer than the novelty ever could think of.

Someday Speedy, I pray to the good Lord our God that will find that sentence as funny as I do right now.

-5 for being that unimaginative when it comes to police agencies in NYC. NYPD PAPD MTAPD TBTAPD Parks Police NYC Sheriff DEA USMS FBI Police Secret Service Amtrak Police State Police And that's just off the top of my head. Hatzolah, those lovable fun bunch of guys, have been pretty much exonerated in having a role in the Crown Height's riot. It is pretty much excepted fact the Jewish occupant was removed first under the direction of NYPD for his own, and the Hatzolah crew's, safety. There members driving at breakneck speed in Crown Victorias with fire engine sirens through the streets of Manhattan, well, that still annoys people.

Probably wouldn't hurt to board and collar this guy...

If only he had a lightbar on his car, it would be complete. Plus he needed some patches. And a stethescope.

That's right folks, the queen of text message contractions and run on sentences is the director. Yep. She's in charge. This is why I don't go to horror movies anymore. Life is frightening enough. Anyway, khanek, all I can say is, for all of your "YOU DON'T KNOW" posturing, I'm going to tell you something, you are the one who is deluded. You can pretend to be all experienced and worldly and know what the real deal is, but the truth is, you are living in a fantasy world and all it would take is for you to be on one BAD call, one REALLY bad one, and you and and your new found friend would be talking out of the other side of your mouth. If I gave you one patient, just one of the ones I've had where I have had to pretty much throw the entire medication bag, almost every function the monitor has built into it and done some fancy airway work on to stabilize, you would understand. The day may come when you confidently give someone that nitroglycerin and they might just turn pale, cool, and diaphoretic and then lose their pulse. Then you will be screwed. Anyway, good luck with everything, I'm glad everything turned out well for your little girl.

Funny you should ask about cocaine because after a recent call I've been doing some research into the differing pharmacodynamics of cocaine. Cocaine is interesting because it has two different effects that almost seem contradictory. Cocaine is first a potent central nervous system stimulant. It accomplishes this partially by blocking reuptake of dopamine at the transporter protein level, causing dopamine to accumulate in the extracellular space, prolonging the dopaminergic signaling of the post synaptic cleft, or at least that's what my book tells me. The other effect comes from its sodium channel blocking qualities. Cocaine's use as an anesthetic comes from its ability to raise the action potential of nerve cells, providing local anesthetic properties. Neat, ain't it?

EMS49 took care of most it for me, but I'll throw in my $1.96. First of all, those patients where you could "just tell" that they needed fluids? You couldn't. You can't "tell" if someone is simply hypotensive from dehydration until you rule out a cardiac cause. You rule out a cardiac cause by using an EKG. Same with asthma. Until you rule it out with an EKG, its never just asthma, particularly in anyone over the age of 40. Secondly, if you want to help the community, but don't want to go to school to learn proper practice, feel free to collect donations for the needy, read to kids at the library, pick up garbage, help old ladies to cross the street. Playing with human lives is nothing to be taken lightly, even with the best of intentions. Lastly, basics are just that, basics. I can't get to the call if I don't tie my shoes, but no one ever harps over how important it is to learn proper shoe tying. I mean, it is important, don't get me wrong, but we kind of just assume it. You know something, there are people out there, really awful people, who create these levels knowing fully the risks involved and fully the consequences, and still dangle them out there for well meaning people to snap up so they save a few bucks. I can't imagine the horror and panic that goes through an inadequately prepared provider when the crap really hits the fan. Someone out there things its a good idea to have kids doing invasive procedures and surgical airway techniques on critical patients, because they know if things go bad, they aren't going to be the one losing everything when the tort lawyers come calling. Me, I think its just plain wrong.

They bite!

EMTP. sorry if you took offense, I was just offering my comments on why the news media is the way it is. Its always been that way, and it will always be that way, ever since someone chiseled on a tablet an in depth look at the mind of the invading Goths. If you ever really want good, semi-non biased news, the BBC does it pretty well. You can also listen to NPR, but be forewarned, you might end up eating tofu and wearing birkenstocks.

I think the Native American population may want to beg to differ about crime rates during the Old West, particularly when it came to things like land rights. In an area where a population polices itself, then of course crime rates will be lower because reported crime rates would be lower, because there is no one to report to. I don't think when someone slaughtered a Native American encampment, each death was duly reported as a homicide. Like you said, there are plenty of variables to look at, but I hesitate to think the days of the Gold Rush and the OK Corrall were the Pax Americana. By the way, when the 2008 election comes, and the right wing types run on platforms of MORE GUNS FOR SCHOOLS FOR THE SAFETY OF YOUR CHILDREN, I am gonna be at home with a cold one, laughing my fool head off.

NYC_EMT, if its anything you want to talk about, PM me.

Another cellar hole saver weighs in. Shouldn't you be rushin in to battle the red demon as the flames rage and stuff or whatever? Leave the medicine to the professionals and go get another tattoo. Why is it almost every single firefighter who comes on here acts like a complete and utter a--hole? You just further my opinion.

:shock: Whoa, whoa, whoa, WHOA... hang on a second... hang here, I gotta wipe the tears of laughter from my eyes. You and your dad, both sat down, and said "Yep, in the OLD WEST, the WILD WILD WEST, politicians DID NOT get shot because people were afraid to shoot each other because everyone had a gun." I mean, you really belief that. You actually, really believe that's what happened. Wow. I'm not sure whether to be afraid, laugh, or just shake my head. People go to high school. They graduate. They live in this country. Yet they seem to be on a different planet. I guess that's all the gun lobby really has in its favor, eh? Anyone else wanna jump in on this before I come off as the elitist snob guy again? Please?

Ten codes can be useful in high volume radio traffic areas, such as a metro area. They're really not that useful to keep things hush hush because pretty much anyone who has the foresight to own a scanner will have the foresight to learn ten codes. Sometimes privacy issues can be eliminated by using common sense. How much does the dispatcher really need to know? Do you need to say you have a 40 y/o male DOA hanging from the ceiling fan dressed in a little school boy's outfit holding an all day sucker? Nah, you probably could get away with requesting appropriate resources. Remember, the dispatcher is not your friend, the radio is not your cellphone, and the world is listening. I not only don't say anything over the radio I don't want my aged grandmother having to hear, I don't say anything I wouldn't be comfortable defending in a court of law.

Sorry Rich, I never bought the "It keeps us in business" line. Saying BS calls keep us in business is like saying criminals keep cops in business. There may be some truth to it, but it doesn't mean that we should accept it. I know agencies like ours don't mind BS calls so long as they have Medicare or Medicaid and I can check the "ALS assessment" box, but you know something, its still wrong. Everytime an ambulance goes somewhere, lights and sirens or not, it puts people at risk. It puts the crew at risk, the public at risk, and the patient at risk. People dialing 911 for routine and chronic medical problems, or for reasons other for than what 911 EMS response was designed for is wrong, even if we make money doing it, its still wrong.

Just to let all of you out there in gun land know, this is why people are more afraid of the NRA than lone gunmen. So, keep it up you guys, keep up the rhetoric, keep up Charlton Heston and your cold dead hands stuff, keep saying how firearms a good thing as people bury their loved ones, rush to the presses as people grieve, more politicians will desert you, more rationale, law abiding gun owners will drop you like a bad habit, and your articles will do more to restrict gun ownership than Hillary Clinton and 8,000 left wing eltist eggheads could accomplish in a decade. Then again, with all those guns, its hard not to shoot yourself in the foot.